Most primary care visits don’t need to be seen in the office

I ran a hospital in the 90′s where we tried this, along with other hospitals in the network. It allowed us to give first aid, home care, and refill guidance without taking up patient and doctor time. Providers were salaried, but had an empanelled population.

After the second lawsuit in the network for failure to diagnose it was cancelled, despite the fact that we set it up specifically to assist patients but limit liability exposure. All contact that wasn’t face-to-face contained a disclaimer, was limited to common sense guidance, and included an offer of an appointment (a specific one, not just “call the appt line”).

We couldn’t overcome the perceptions and expectations (people hear what they want to hear), or the litigation opportunity it offered.

I could provide better care to patients if my time spent on email communications and phone communications was properly compensated. As it is now, I can only get paid for face-to-face interactions. Ironically it is most likely costing the companies MORE money to not cover those other services. There are many things that could be handled by a 5 minute phone/internet interaction for a smaller fee. The patient might not even have to leave work, thereby increasing productivity for our country.

I would love to do other patient interactions, but if I provided them for free all day long then I would go broke. I have overhead to make.

Pay me $25/email and $25/phone call and I’ll be on the computer with a phone on my desk 24/7. I’ll even be there in the middle of the night playing the Sims waiting for an email and phone call. Pay me. Bottom line. Pay. Me. We had a study that paid the cab driver $50 to pick up the patient to bring them in for a visit. I said pay me $50 I’ll go get them myself. I’ll throw in the return trip for nothing.

The point of physician extenders is to improve access for patients. Do I really need to be involved with a routine BP check? Can’t I just have them get a BP check at a walk-in station and then I can send them a message later to have their medications adjusted. Do, I have to make a patient book an appointment and pay a copayment for that? Now that I not busy doing that type of work, I can see my patients for urgent visits or spend more time with them to discuss wellness. If the physician shouldn’t be involved with a type of work, then they shouldn’t have to be. There are more important things for us to do. The point however, is not to replace the doctor-patient relationship. It is just meant to make us more efficient. I can titrate insulin a whole lot faster if patients can just send me their readings weekly. Heck, why don’t I just give them a flowchart that gives them specific instructions on how much to increase their bedtime NPH by based on their weekly readings.

“Can’t I just have them get a BP check at a walk-in station”

Physician extenders is a phrase used to describe a physicians assistant or a perhaps a nurse practitioner, not someone in a lab or a medical assistant. The patient didn’t really see a provider, only someone to gather information.

Does it really matter if you see the doctor for urgent things and the physician assistant for chronic problems and check up or visa versa? Doesn’t that make me just a chart to everyone at the clinic, where no one actually sees the progression of disease, only the write up. What did you miss because you didn’t actually see the patient?

I don’t know of many of my patients that could be managed that way-I have many 90 year olds, and frequently what the patient thinks is the matter has nothing to do with the exam. I think there is no substitute for eyeballing a patient. Yourself.

Relying only on using more phone and email is not the answer. Instead, better options would be : increase number of providers, create better triage to limit unnecessary visits, pass tort reform to get a handle on liability issues (which create many unnecessary visits due to defensive medicine,) and educate society (mandatory health courses in school about the SCIENCE of their bodies and how the medical system works and what it’s limitations are.)
A good part of my time is spent dealing with medically illiterate/unsophisticated people who don’t understand the first thing about the science of their bodies or medical science. This is big problem because they panic easily, and they have demands which are unrealistic.